NHS Procurement: Palantir Contract

Baroness Hayman of Ullock Excerpts

Thursday 22nd June 2023 Lords Chamber

[Lord Markham (Con)]

As I said in a previous Answer, we are in the process of disposing of those contracts. On many occasions, it is easy to look with hindsight. Noble Lords may remember that, at the time, there was a massive rush and countries were gazumping each other to get hold of PPE. It was very much the feeling of this House, and all the people in the UK, that we had to desperately contract suppliers to do it. Did we make mistakes? Yes. Were we right on more than 90% of occasions? Absolutely. To keep the front line going, we needed to order more than 9 billion essential items, and we did so using the very system that we are talking about here in respect of Palantir. There are circumstances—Covid is a prime example—where it is appropriate to do those sorts of direct awards. That notwithstanding, I think we all fundamentally agree that an open, transparent and competitive tendering process will always be preferable.

[Baroness Hayman of Ullock (Lab)]

My Lords, the £25 million contract awarded this week is a drop in the ocean compared with the £480 million that is on its way. The scope of the federated data platform is vague, but there is no doubt that the data it stores will be both vast and sensitive, so it is vital that any procurement process is fair and transparent and enables the public to engage with it so that the system works as intended. However, 48% of adults, when asked, said that they were likely to opt out if it was introduced and run by a private company. This would have a catastrophic impact on the quality of NHS data, which is an extremely valuable resource. Do the Government recognise this as a risk? How will they ensure that we have public faith in the process?

[Lord Markham (Con)]

The noble Baroness is correct: public confidence is vital, particularly in the case of data, where we are concerned about privacy. We are arranging a briefing of noble Lords so that everyone can have the opportunity to understand what we are talking about here, which is almost like the plumbing of the system. The NHS maintains primacy of use—it is the only organisation allowed to use it—and privacy will be maintained at all times. It is much better to think of whoever wins this contract—we do not know who they are—as just the technology provider, like Microsoft, for instance. We use private sector companies for technology all the time. The key thing is that the provider is protected. That is the NHS, and no one else can get access.

Diabetes

Baroness Hayman of Ullock Excerpts

Wednesday 9th January 2019 Westminster Hall

[Sir John Hayes]

With the insight and acumen that characterised my right hon. Friend’s ministerial career, he has identified a point that I was going to make later. With his permission, I will amplify that in my speech. I was aware of his personal circumstances and of his expertise as a result of having a daughter with diabetes. He will recognise that the average sufferer spends about three hours a year with a healthcare professional. Self-management is therefore critical and, in turn, technology is essential to such self-management. We cannot expect a healthcare professional to be on call every time someone needs support or the kind of treatment that is routine for someone such as my right hon. Friend’s young daughter. I entirely endorse his remarks. The Minister will have heard them and will respond accordingly.

In essence, I want a world in which all people with diabetes have access to the right information, advice and training, not just at the point of diagnosis but throughout their lives. People will say, “Well, of course, we all want the very best, and we all want the ideal,” but if we do not aim for the very best, we will get something very much less than that, so I make no apologies for being definitive in my determination to aim for that ideal. It is critical that we as parliamentarians should look to more distant horizons than sometimes the prevailing powers in Government—as I know from my long experience of that—would encourage us to do. Such debates as this allow us to do that in a cross-party way, for this is not about party political knockabout but about something much more fundamental.

Only if we can achieve the ideal will people be well placed to gain confidence and to cope as the Prime Minister does—as I have described—and as the deputy leader of the Labour party does. They can manage their condition and do not have their lives inhibited by it, and so believe that their opportunities are unaffected by the condition.

To ensure the early uptake of education, it must be provided in a useful format: digitally and through every kind of agency, whether that is schools working with health professionals, or local authorities, which have a responsibility for public health following the Health and Social Care Act 2012, stepping up to the mark too. I shall say a little more about the co-ordination of that, although the Minister is already aware of my concerns. It is about ensuring that our public health effort on diabetes is co-ordinated, consistent and collaborative. That is vital, for reasons already mentioned by colleagues in interventions.

I welcome the commitment in the NHS long-term plan, as I said, to expand the support on offer for people with type 1 and type 2 diabetes, including through the provision of structured education.

[Sue Hayman (Workington) (Lab)]

The right hon. Gentleman is making incredibly important points. He mentioned the deputy leader of the Labour party, who turned his life around through diet and exercise—nutrition. That is an incredibly important issue in my constituency. Throughout west Cumbria, we have serious levels of diabetes, health deprivation and obesity. I thank the right hon. Gentleman for making what is an incredibly important point about bringing together health education at a very young age, and I encourage the Government to invest in that.

[Sir John Hayes]

I hope that the Minister, in respect of that excellent intervention and my earlier remarks, will say how he will ensure that that kind of vital education is provided in a format and at a point that works for everyone. This is about getting to people by a means and at a place that will penetrate, have effect and be comprehensible. The objectives in the long-term plan are right, but how we deliver those objectives has become the vital next step.

We have already spoken in this debate about technology. A flexible approach to the provision of technology, as well as education and support, is critical. Once equipped with information and skills, people must have access to, and the choice from, a range of technologies to help them to manage their condition in everyday life, as my right hon. Friend the Member for Ludlow (Mr Dunne) mentioned a few minutes ago. For people with type 2 diabetes, that is about ensuring access to the required number of glucose test strips. In the rapidly developing world of type 1 technology, insulin pumps and continuous glucose monitors can radically transform lives.

Decisions on which technologies are available should be made with reference to advice from clinicians, patients and, perhaps most importantly, health economists, who will help to determine value to the NHS.

Surgical Mesh Implants

Baroness Hayman of Ullock Excerpts

Wednesday 18th October 2017 Westminster Hall

[Emma Hardy]

I absolutely agree with that. That hospital would neither confirm nor deny that those young girls had been operated on. For background information, all the colorectal surgeons who the programme spoke to said that the young women should have been offered other avenues before surgery. The programme also highlighted the extremely concerning practice of one surgeon attaching part of the rectal mesh to the soft tissue on the wall of the vagina. The shocking reason for subjecting women to this was explained by one consultant, who stated that if the rectopexy mesh is fitted in that way, the surgeon can charge for vaginal repairs as well as for fitting the mesh. Some of the patients being operated on were not aware of where the mesh was being attached, which raises serious questions about the warnings patients are given.

We must remember that it is not only women affected by this issue; men and women are suffering from chronic pain after having mesh surgery for hernias, using the same material—usually polypropylene plastic—used in vaginal mesh surgery. Research shows that between 10% and 15% of people who have had hernia mesh surgery suffer from chronic pain and complications after surgery. However, as with vaginal mesh surgery, not enough information is available to understand the extent of the risks of surgery.

Thankfully, there are organisations that help those affected to tell their stories. The Sling the Mesh campaign has done an incredible job in highlighting the problems, but there must be a wider effort from the Government to inform members of the public that this is an issue and to encourage them to speak out if they experience problems. Thousands of people have had the procedure over the past two decades without knowing what would happen if their body rejected the plastic mesh or if the mesh harmed their internal organs, leading to many people wanting the mesh removed. However, mesh removal is not a simple solution.

[Sue Hayman (Workington) (Lab)]

My constituent Alison had a mesh put in too tight. She was in appalling pain and had to travel all the way from Cumbria to Manchester to get treatment. Now she has had it partially removed, she is in a worse state than ever and has to go back to Manchester again. Does my hon. Friend agree that something has to be done to help people with removal?

[Emma Hardy]

I absolutely and completely agree. One consultant has written to explain the problems with mesh removal, stating:

“Once stuck the mesh is never fully removed and failure of implanting means that mesh will fuse, erode, stick and adhere to organs, nerves and blood vessels—creating life long…injuries.”

She argues that patients were never clearly told of the risks of mesh fused to organs. She stated further that the

“mesh weave that is stuck will become a perfect breeding ground for bacteria”,

and unless it is completely removed, the patient will remain continually infected and fatigued forever.

NHS and Social Care Funding

Baroness Hayman of Ullock Excerpts

Wednesday 11th January 2017 Commons Chamber

[Sue Hayman (Workington) (Lab)]

The Government say that their success regime for the NHS in Cumbria is about transforming health and social care to create a

“centre of excellence for integrated health and social care provision in rural, remote and dispersed communities.”

That sounds fantastic—it sounds like exactly what we need. If that is the case, though, why are local people are so concerned about the actual proposals that there is a petition for a vote of no confidence in the regime? Why did the Secretary of State himself say earlier in the debate that he has profound concerns about the quality of care in Cumbria?

West Cumbria is set to see rapid population growth, owing to the proposed nuclear new build at Moorside, alongside proposed coal mining and tidal energy projects. There are concerns that none of this is being taken into account. Nevertheless, I shall focus on my particular concerns about the proposals for maternity services and community hospitals.

First, on maternity, the highly skilled and experienced midwives in west Cumbria have told me that the success regime’s preferred maternity option is not their preferred option. The idea behind the success regime is to

“bring more care closer to home”,

with a model that would

“ensure provision of safe, high quality care and provide a first class experience”.

But the midwives ask how that can be achieved through the proposals to change maternity care at West Cumberland hospital when the success regime’s preferred option sees the choice of birthplace removed from hundreds of women and would potentially see severe delays in women and babies receiving life-saving assistance. The clinical outcomes and satisfaction rates at West Cumberland hospital under the current maternity care system are excellent and show that safe, high-quality care is being provided. The proposed changes would bring inequality, preventing fair access to maternity services across the county, and discriminate against west Cumbrian women who would no longer have a choice in maternity care, particularly those who are vulnerable owing to deprivation and social isolation.

The proposals will mean that around 700 additional women will deliver their babies at Carlisle every year, but where will they be cared for? The Cumberland infirmary in Carlisle already struggles with its current workload. West Cumbrian mothers need proper answers on this. In addition, a proposed new garden village is to be built south of Carlisle with 12,000 new homes. How on earth is the Cumberland infirmary expected to cope?

I am particularly disappointed that there is no option in the current consultation document to keep beds at Maryport and Wigton community hospitals. All the proposals remove all the beds at those hospitals. This will be particularly difficult for the relatives of patients who are having end-of-life care, because they may be elderly and have their own medical conditions. With no transport of their own, travelling to visit family members can be particularly arduous.

Both hospitals serve areas with considerable deprivation and very poor local transport links. Patients and families in Maryport may have to travel to the community hospitals or the acute hospitals. Journey times would be long with poor bus links, making it difficult for elderly and disabled people.

The people of Maryport feel very strongly about the changes and have run a passionate campaign to show people involved in the success regime just how much the community hospital means to them and how it is an integral part of the local community. They are deeply upset at the removal of the beds.

It is imperative that all services are delivered as close to people’s homes as possible. This must include the retention of beds at all our community hospitals and the retention of consultant-led maternity services at West Cumberland hospital.

I shall finish with a very personal experience, which relates in particular to beds in community hospitals. Not long before Christmas, my father was taken seriously ill. We managed to get him transferred from the acute hospital to his local community hospital, which was within walking distance of his home. He knew the staff at the hospital, and the district nurse was able to call in to see him. When it became clear that he was at the end of his life, we tried very hard to get him moved home—we had a hospital bed set up in the living room. Unfortunately, the move was not possible. However, unlike the experience of my hon. Friend the Member for Chesterfield (Toby Perkins), my father had a good death in his community hospital. All my constituents should have the same opportunity that my family had. We were able to be with my father at the local community hospital where he knew the staff and the district nurse who came to see him. If we remove palliative care from our community hospitals, we will be making a terrible mistake.

--- Later in debate ---

[Dr Allin-Khan]

Many people who go to A&E know that they should not be there. I have had elderly patients saying to me, “I’m so sorry, doctor, for wasting your time.” But what other option are the Government leaving them? That is what we are debating today. The Secretary of State wants an honest conversation—well, let us have it. Let us talk about the impact that the current state of the national health service, which he has been in charge of for four years, is having on accident and emergency departments and throughout hospitals in this country. Let us talk about rock-bottom staff morale. Let us talk about the breakdown of staff marriages, a rise in depression among staff and the fact that waiting times are not the responsibility of patients. They are not to blame.

Rising waiting times are the Secretary of State’s responsibility, yet he blames them on the number of people going to A&E since the target was set. It is his responsibility to lead a national health service that can meet the needs of its people, but again he pleads innocence. He says that no other countries have such stringent targets, suggesting that it is unfair that we do. The meeting of the A&E target in particular, not watered down but in full, is what establishes the NHS as the best health service in the world, and one that we can, should and would be proud of under a Labour Government. After all, emergency departments’ ability to meet the four-hour target is directly related to the health of the NHS itself. It is simple: more people go to A&E when they have no other options available.

[Sue Hayman]

On those options, the use of A&E in my area of Cumbria is entirely down to the lack of GPs. With so many GPs reaching retirement age, the situation is only going to become more acute. Does my hon. Friend agree that the Government need to tackle this matter urgently?

[Dr Allin-Khan]

I wholeheartedly agree with my hon. Friend. She makes an eloquent point about the lack of GPs and the problems we will face when more retire. Three GPs in my constituency contacted me this week to say that they had been offered jobs that were subsequently retracted due to financial pressures.

The Secretary of State pleads innocence. He says no other countries have such stringent targets. We should not compare ourselves to the worst; we should be leading as the best. The explosion of waiting times is his failure and a sign of the dangerous erosion of one of the country’s greatest institutions. As we saw last week when the British Red Cross had to be drafted in to our hospitals, our NHS is in crisis. Yet instead of listening to doctors and fixing the systemic problems they have created, our Government are repackaging the A&E four-hour target to try to save face and take attention away from the real challenges: the challenge of social care packages not being in place, prohibiting flow through A&E departments; the lack of access to GPs across the country, making A&E the only resort; the chronic underfunding and significant cuts in funding at local authority level; doctors and nurses being forced to miss breaks, as we heard earlier today, and working 14 hours, some without a break, sleep-deprived and unsafe to practise clinical work; and an NHS staff who do not feel supported, encouraged or motivated by the Government. None of these things will be addressed by a watered down four-hour target.

Having spoken to the Royal College of Emergency Medicine, those working on the frontline at all levels, and those who are training our junior doctors, I would like to put forward questions for the Secretary of State to think about. Why has it been decided that the four-hour target will now be downgraded? Who has been consulted on that? Which body said it would be beneficial to patients and A&E staff across the trusts? How will he define major and minor health problems? How are doctors and nurses magically meant to know, at first sight without proper assessment, whether it is a major or minor health problem? Who is responsible if a seemingly minor condition is actually life-threatening? Will it be him? Who will be responsible? How will the Government explain that we will be going back to the days when patients could wait over 12 hours if they were not considered ill enough?

The Secretary of State must recognise the impact of this systemic crisis on A&E rooms across the country in his words and in this decision. In downgrading the target, the Secretary of State does neither, instead placing blame on patients and putting patients at risk. Let me tell it straight: I have been an A&E specialist doctor under a Labour Government and under a Conservative Government. There has been a change under this Government—and for sure it has not been for the better.

Health Service Medical Supplies (Costs) Bill

Baroness Hayman of Ullock Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Justin Madders]

My hon. Friend is absolutely right. That is one reason why we must tread carefully, and hear what regulations the Government produce for consultation.

Some of the measures did not form part of the initial consultation, and there is a feeling that they have been added to the Bill at the last minute. Given the damaging cuts to the community pharmacy sector that were announced only last week, there is an anxiety about what costs could be created by any additional administrative burden.

[Sue Hayman (Workington) (Lab)]

Does my hon. Friend agree that pharmacists often know their patients much better than over-stretched GPs do? They can also advise on the prescription of appropriate cheaper drugs. Does he also agree that, instead of putting further pressure on the pharmacy sector, the Minister should be supporting it to reduce the burden on GPs and to help the NHS save money?

[Justin Madders]

My hon. Friend is absolutely right. There was real concern about the announcement last week. From the surveys that have been taken, we know that approximately one in four people who currently use the pharmacist would go to their GP if they were unable to seek advice from the pharmacy. We know the pressure that GP surgeries, and indeed the NHS, are under. We will have to watch carefully the impact of these proposals, which I hope will not be as serious as a number of Members fear.

The impact assessment does not offer many clues. It states that the additional costs that could be incurred

“have not been quantified, as their magnitude will not be known until after consultation on subsequent regulations.”

We need to tread carefully. The Secretary of State is asking us to give him new powers before setting out exactly how he will use them. That is a far from perfect state of affairs. I hope that we will get some further clarity when the Bill reaches Committee.

Community Pharmacy in 2016-17 and Beyond

Baroness Hayman of Ullock Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[Sue Hayman (Workington) (Lab)]

Allison’s pharmacy in Cockermouth in my constituency helps to promote good health because it has a deep knowledge of the patients and their families. My concern is that, as a small pharmacy, it will be under more pressure from these cuts than the larger ones will be locally. Does the Minister recognise this pressure? Does he also recognise the vital community role that local pharmacies can play?

[David Mowat]

I repeat that we absolutely recognise the vital role that community pharmacies can play, and we want to make them move towards an even more vital role by providing more services, which is what pharmacies want to do, rather than getting all their money from their dispensing activities, as they do at the moment. High quality pharmacies will be in a position to really prosper in the new world that we are talking about.

Community Pharmacies

Baroness Hayman of Ullock Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

All I can do is repeat the point that I made earlier. The Government completely agree that we need community pharmacies. The Government completely agree that they have a vital role to play in keeping patients away from GPs and, potentially, from A&E as well. That, however, is not the same as saying that the 11,800 pharmacies that we have at the moment are precisely the right number, or that the clustering is at precisely the right number as well. It is right for the Government to review this and to establish whether or not the £25,000 of NHS money that every pharmacy receives every year is money well spent.

[Sue Hayman (Workington) (Lab)]

As we have heard, pharmacies have the potential to help the NHS become more efficient and community based. Community pharmacies are an integral part of the integrated care communities that the Success regime in Cumbria is promoting in order to take the pressure off our overstretched GPs and A&Es. We are really struggling to recruit doctors in Cumbria, so any loss of community pharmacies is a serious loss to our community. Can the Minister assure me that these wider health challenges are being taken into account?

[David Mowat]

Yes, I can assure the hon. Lady that we fully understand the issues in places such as Cumbria. To an extent, the access scheme is designed to make sure that large rural communities are properly protected. I can only repeat that we value the services that pharmacies provide and that we do not believe that there will be a substantial detriment to them as a result of a bit less clustering.

NHS Sustainability and Transformation Plans

Baroness Hayman of Ullock Excerpts

Wednesday 14th September 2016 Commons Chamber

[Mr Dunne]

I am grateful to the hon. Gentleman for his kind words about my willingness to take interventions from both sides of the House.

I am interested that the hon. Gentleman should mention funding allocations. Across the NHS, the allocations are a legacy of the formulas that were set in place by the Labour Government, of which he was a member. People across the country, not least in rural areas such as Shropshire, cannot understand why the funding per capita is much less generous in some parts of the country than in others. I am taking an interest in that and would be willing to sit down with him and other colleagues to understand the particular circumstances in north-west London, which we will have to do after the coming recess.

Returning to the progress that is being made, all the plans are expected to present an overall strategy for their area and to identify the top three to five priorities required. In the most advanced plans, we are also expecting areas to set out how they will deliver a number of national priorities, including on mental health and diabetes. Some will build on the early work of vanguard or Success Regime joint working, which has been developing better co-ordinated care models over the past year or so.

[Sue Hayman (Workington) (Lab)]

Will the Minister give way?

[Mr Dunne]

Shortly. I must make some progress.

The plans offer the NHS a unique opportunity to think strategically. For the first time, the NHS is planning across multiple organisations—both commissioners and providers—with local authorities to address the whole health needs of an area and the people it serves. Also for the first time, the NHS is producing multi-year plans showing clearly how local services will develop over the next five years to deliver real improvements in patient care and better efficiency to ensure that the NHS continues to be able to cope with rising demand from our ageing population. That is leading some STPs to face up to tough choices about the future of some services. Such choices have often been postponed again and again because they were too hard or relied on individual organisations operating on their own to shoulder the responsibility rather than it being shared across the geography or the whole healthcare economy.

--- Later in debate ---

[Mr Dunne]

There is undoubted pressure on infrastructure, as there is on technology. As technology improves and becomes available to the NHS, it provides opportunity—for example, for much more care to be undertaken closer to the patient. In many cases, this can be done increasingly in or near their home. That will have consequences for our existing infrastructure estate, and some of that will lead to a reconfiguration of existing hospital services. There is a programme of renovation across our hospitals, but of course that cannot get to everywhere at the same time. I apologise to the hon. Gentleman that he does not have the shiny new hospital that he would like, but there is a building programme, which will continue in the future.

[Sue Hayman]

rose—

[Mr Dunne]

I will now give way to the hon. Lady, who has been very patient.

[Sue Hayman]

I appreciate that. As the Minister is aware, we face particular issues in Cumbria, which has led to our having the Success regime. We are about to go into consultation on that, in key areas such as maternity, accident and emergency and the community hospital’s future. My constituents are concerned about how the STPs are going to fit in with the Success regime, what the fit will be and whether all that will be challenging and confusing.

[Mr Dunne]

As I have said, and as the hon. Lady knows, the Success regime in her area will become subsumed within the STP, but the advantages for areas in the Success regime is that it means the organisations have been working together for much longer than in the pure STP areas, and that will bring benefit in terms of the maturity of their plan and their willingness and ability to implement it.

Carers

Baroness Hayman of Ullock Excerpts

Thursday 9th June 2016 Commons Chamber

[Sue Hayman (Workington) (Lab)]

I thank the hon. Member for Eastleigh (Mims Davies) for securing the debate. I am sure that this is an issue that touches many hon. Members. In my family, my father needs caring for, and the circumstances will be the same for many of us. As our population ages, the situation will only get worse.

I want to focus particularly on carers’ finances, as the struggle that many carers face in making ends meet has been raised with me repeatedly by my constituents, including Graeme McGrory, who cares for his partner Ann, and who has explained to me that the carer’s allowance—the main benefit for carers—is the lowest benefit of its kind. It works out at £1.77 an hour. If we compare that with £7.20 for the national living wage, we can see that there is a huge gap. In a 35-hour week, that gives a difference of £170 a week. I cannot imagine that there are many carers out there who work only 35 hours a week; I imagine most work much longer.

It is not just that the carer’s allowance is so low. The Government also need to make sure that when any changes are made—for example, to the minimum wage— or when any welfare reform is implemented, the impact on carers is properly assessed, so that they are not affected negatively. For example, at the moment the carer’s allowance threshold is £110 a week. Before April, if a carer worked for 16 hours a week on the minimum wage, they would earn £107.20 a week, but the rise in the minimum wage that came in in April means that the same person is now earning £115.20. That is not a lot more, but it is enough to take them above the earnings limit. That puts carers in a difficult position. What are they supposed to do?

[Louise Haigh (Sheffield, Heeley) (Lab)]

This has happened to a constituent of mine, and I can tell my hon. Friend what she had to do: she had to drop her working hours from 16 to 15 a week, because working 16 hours a week put her £5.20 over the income threshold and took away every penny of her carer’s allowance. I implore the Minister to look into this, as it would only mean a £5.20 increase in the income threshold for carer’s allowance. I would really appreciate it if he could come back to this issue in his remarks.

[Sue Hayman]

I thank my hon. Friend for that incredibly important point. If someone has to choose between cutting back on work or losing their entitlement, they are between a rock and a hard place. I do not want to believe that the Government would want to punish carers in such a way. I agree with my hon. Friend that this needs to be reviewed urgently. I hope that the Minister will consider reviewing the threshold, and that in future any changes will be considered from the perspective of the impact on people in receipt of carer’s allowance, to ensure that they do not suffer unnecessarily.

There was the same problem of the Government not looking at the impact of new policies on carers when the bedroom tax was introduced. The Government introduced the change without considering the impact on carers, and without properly understanding why a spare bedroom can be so vital for families with a disabled, chronically ill or terminally ill member.

These are the reasons carers are struggling so much to cover basic living costs. That is particularly hard when family members have had to cut back on working hours to care for somebody; often, they will have given up well-paid careers. If the person being cared for has also had to give up their job—for example, because of an accident at work—that means that the family has to cope with a really steep drop in income. On top of that, if the family have children or are caring for elderly relatives, they are under a lot of stress and pressure. As the hon. Member for Eastleigh said, carers do society a huge service, saving all of us taxpayers a lot of money—an estimated £132 billion a year. If carers were to go on strike—perhaps they should if they want to get attention—imagine the impact on the NHS and local authorities. The people they care for could not just be abandoned.

The Government need to commit to helping, and to improving dramatically the situation for many carers. They also need to recognise that this dramatic loss of income often leaves carers with an increase in other costs. Carers UK’s recent inquiry found that carers can face higher utility bills, transport costs and shopping bills. On top of that, they might also need to bear the cost of adaptions in the home. The recent report by the New Policy Institute found that there are now 1.2 million carers living in poverty. That is simply not good enough.

If we consider ourselves to be decent, compassionate people; if we believe in society and community; and if we recognise that any one of us here might become a full-time carer, or might need care, we must pledge to do more. We must come together to support carers, who do such an important job in our society and who are often exhausted, both physically and emotionally. We have to say: enough is enough. It is time that the Government stopped the shameful situation in which carers and their families are pushed into poverty. It is time that we all said, “Enough.”

Budget for Community Pharmacies

Baroness Hayman of Ullock Excerpts

Tuesday 24th May 2016 Commons Chamber

[Michael Dugher]

My hon. Friend is exactly right. I know what a formidable campaigner she has been on this issue in her local community. I pay tribute to her, and not simply because she is also my Whip and occasionally allows me to go home—though I would not rule it out as a contributing factor!

The community pharmacy network is made up of trusted local chemists who are rooted in the communities they serve. I do not doubt that the Minister and his Department share with me an understanding of the vital importance of community pharmacies. Indeed, in the Government’s own letter last December to the Pharmaceutical Services Negotiating Committee, which announced the cut, it was stressed that community pharmacies must be at the “heart of the NHS”. The letter went on to praise the excellent work of community pharmacies

“in prevention of ill health; support for healthy living; support for self-care for minor ailments and long-term conditions; medication reviews in care homes; and as part of more integrated local care models.”

That is all true, so why on earth are the Government pressing ahead with a massive arbitrary budget cut for community pharmacies that will, by the Minister’s own admission at a meeting of the all-party pharmacy group in January, potentially force up to 3,000 local chemists to close?

A properly funded and well-resourced community pharmacy sector is vital for enhancing public health, reducing risk to the public and mitigating downstream costs to the NHS. This is the key argument. In his response, the Minister will no doubt rightly draw on the financial pressures facing the NHS, but is not this cut in the community pharmacy budget a false economy? By contributing to improved public health—frankly, by heading off some people at the pass—our community pharmacies prevent patients from resorting to visits to the GP surgery or the local hospital.

The Government’s timing could not be worse We need our community pharmacies more than ever, given that we have an NHS that is so self-evidently in crisis. A&E departments are under enormous pressure on the Government’s watch. In the three months to March this year, only 87.9% of patients visiting them were seen within four hours, which missed the Government’s own target of 95%. Despite the brilliant efforts of NHS staff in my own area—which was visited recently by my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), in his capacity as shadow Minister—the figures were even worse, and, indeed, were going backwards. Just 86.7% of patients were seen within four hours in Barnsley Hospital’s A&E department, down from 87.2% in February and 89% in January.

Cutting the budget for community pharmacies will do nothing to alleviate the crisis. In fact, Ministers risk deepening the problems that face our A&E departments by removing access to the medical advice that those pharmacies offer before patients feel the need to go to hospital.

[Sue Hayman (Workington) (Lab)]

Allison’s chemist in Cockermouth, which is in my constituency, provided a very important resource for local people after the floods. Rather than people going to hospital because they needed care, Allison’s visited them in their homes or where they were staying. This cut means that we shall risk losing that kind of important support.

[Michael Dugher]

My hon. Friend has given a compelling example of the contribution made by community pharmacies—not just those in her constituency, for there are similar stories in many other parts of the country.

Another argument for arguing against the proposed cuts is the crisis relating to GP access. Millions of people are waiting longer for appointments: 14.2 million patients had to wait for a week, or were not given an appointment at all, when they last tried to see their doctors in 2015. The truth is that the GP access crisis can only be made worse by the Government’s plan to cut the community pharmacy budget.

The findings of new research carried out by YouGov, commissioned by Pharmacy Voice and published in the report yesterday, show that one in four people who would normally visit a pharmacy for advice on common ailments would instead make an appointment with their GP if their local pharmacy faced closure. The report also states that the impact of the cut would be much more severe in areas of higher deprivation, such as my constituency, and that as many as four in five people would visit their GP if their local pharmacy closed. According to the National Pharmacy Association, that would mean approximately 1 million extra people per month using GP and alternative local NHS services.

In a recent letter to the Pharmaceutical Services Negotiating Committee, the Government said that they wanted

“a clinically focussed community pharmacy service that is better integrated with primary care. That will help relieve the pressure on GPs and Accident and Emergency Departments”.

I could not agree more, but how can an arbitrary cut—because that is what it is—in community pharmacies on such a scale possibly do anything other than make a bad situation in our NHS even worse, and how do the Government plan to introduce a “hub and spoke” dispensing model against a backdrop of thousands of closures in the sector?

Particularly in recent days and weeks, the Government have tried to argue that this is not the arbitrary cut that we all know it to be, and that it is not a raid on the community pharmacy budget in the Department. They now say that it is all about making the pharmacy sector stronger by eliminating what Ministers call “clusters” of chemists. However, in response to a written question on 4 May in which I asked the Government to

“make an assessment of the effect of the budget reduction for community pharmacy in 2016-17 on high street vacancy rates”,

the Government conceded that they could not accurately assess the impact of the cut. They could not say how many community pharmacies would close, or, indeed, where they would close. The Minister said that the Government were

“not able to assess which pharmacies may close or what the effect on high street vacancy rates might be because we do not know the financial viability of individual businesses or the extent to which they derive income from services commissioned locally by the NHS or local authorities or have non-NHS related income.”

As I have already highlighted, the Minister previously said that he estimated that up to 3,000 community pharmacies—a quarter of all those in the country—could close as a result of this cut. However, with no planning, no strategy and no impact assessment, it is painfully obvious that the Government have not the faintest idea which community pharmacies are at risk of closure. It could be a chemist that is located in a so-called cluster, but it might well not be.